Monday, August 17, 2009

bTB Risk - whose?

We touched on the subject of the 'risk' from exposure to mycobacterium bovis, the causal agent of bovine tuberculosis, in our posting here. And steering everything to do with this Grade 3 pathogen is HSE (Health and Safety Executive) who are extremely precise in their interpretation of the EU directives found here.

HSE do not distinguish between laboratories handling m.bovis, farms under TB restriction due to the exposure of their cattle to it, or exposure in the countryside from wildlife. As we quoted in that posting, they require Risk Assessment forms, data logs of visitors and protection offered. Up to date COHSS papers describe m.bovis thus:

Natural hosts: Cows, [but] also found in badgers and deer.Disease in humans: Chronic progressive disease with fever and weight loss.Transmission: Originally through drinking unpasteurised milk. Now from breathing in of infectious aerosols of respiratory discharges and possibly handling meat from infected animals.

We are glad that the 'unpasteurised milk' loophole as the cause of bTB, firmly closed for the majority during the TB eradication schemes of the 1950s and 1960s, is starting to die a death and HSE are at last beginning to wake up to 'aerosol' infection from all infected animals including wildlife. As in environmental contamination.

So what are the implications for farmers whose herds are under restriction from TB?For open spaces where the public have a 'right to roam, and footpaths which cross territory occupied by infected wildlife?For National Trust land, including the 'badger watch' areas of Woodchester Park?

In the words of a litigation lawyer, "there is no such thing as 'low risk'". Either there is risk, or there is not. You can't be a 'little bit pregnant', so no half way house, which is what Defra have been trying to argue with bTB. We have said many times that the level of environmental contamination which the tested, slaughtered sentinel cattle are flagging up, is something which our population, and other mammals have not encountered before. But not only is it reckless and dangerous to put them 'at risk', it may be against the many laws surrounding the control of this pathogen.

From HSE and top lawyers, the advice is that any risk must be advised, both to the public and to employees. Risk assessments undertaken, and all guidelines followed as befits the seriousness of this Grade 3 pathogen. As far as insurance goes, the matter is far from clear. But the gist of today's conversations is that if the steps advised in HSE literature have not been followed, including warning the public of the possible risk, then damages could be considerable.

So who should be responsible? For that and some sense we have to look to Switzerland, where Dr. Ueli Zellweger tells us that the Swiss veterinary authorities use public notices in their newspapers to post details of animal diseases, particularly zoonoses. Thus they fulfill their obligations to 'inform' their population of 'risk', and more importantly, what they are doing to reduce it. That way, he says, they keep the public both informed and on side.

So is there scope here for Defra to actually use the risk assessments which AHO have to complete for every new herd breakdown? These are the ones which the ISG did not use for the RBCT Badger Dispersal Trial, preferring instead to use an 'assumption' of 2 parts cattle to one part badger, give each 'roughly equal importance' and run with that - but let that pass. Nevertheless, they are there and in the SW at least they come firmly down on 'wildlife, particularly badgers' as the cause of the majority (up to 90 per cent) of TB breakdowns in cattle. And this throws wide open the responsibility for such warnings of 'risk'. Given that in many cases, the 'wildlife' causing the problems is not domiciled on the farm which is on the receiving end.

Defra do however have the logistics with which to offer the appropriate 'risk' advice, in the form of their Parish testing maps. If a single farm within a parish has a confirmed TB breakdown, then the parish testing interval is reduced to annually. Twenty years ago, the job would have been quite small - just a scattering of dots on the map of GB - as shown on here and on page 60 of the ISG Final Report.

But two decades of prevarication mean that every parish shown in red on the most recent Defra map is on an annual testing regime. Thus environmental 'risk advice' is a much more comprehensive job.

That does not mean that it can be shirked.

(Maps courtesy of Defra, are Crown Copyright and must not be reproduced for commercial purposes, without permission from the Department of Environment, Food and Rural Affairs. They may be used for news reporting or research.)

17 comments:

I was involved in risk management, continuity planning & disaster recovery whilst an IT consultant.

The UK Govt uses the Orange Book as Guidelines - see below:-

www.hm-treasury.gov.uk/d/orange_book.pdf

This 52-page publication is dated 2004 and was unavailable online when the muck was hitting the fan during the early days of the recent / current financial crisis. It’s available now and is a good read!

As part of my role as IT consultant we explored / implemented Insurance Based schemes using the likes of Lloyds of London underwriters.

The fact of the matter is that the UK government should be able to underwrite anything – and make a profit. Come to that so should the NFU!

The Scheme would be based on the “motor insurance model” – areas being rated accordingl to its bTB rating with individual values for each cow – thus pedigree cattle insured separately etc etc Expensive in Cornwall / Devon – much cheaper in Scotland (if the legislation applied to Scotland!)

Thus cows (etc) would need both an MOT(B) and an Insurance Certificate.

Making such a system compulsory would ensure that New Labour’s vegetarian ministers would more quickly achieve their primary objective of destroying our Cattle Farming industry!

Two points Peter.First of all insurance for farmers for bTB (including consequential losses arising from prolonged restriction and individual animal top-ups), is unavailable to most of us. At any price (premium).We had it for years, but just one prolonged claim made us 'uninsurable' for this disease.(We still have cover for a shed load of others)

We asked in PQs about a government backed scheme, which TB had proposed for bTB in 2003.. The underwriters laughed it out of court. "Exposure to risk is too great " they said, and they weren't talking about cattle.

The insurance market for agriculture in general, is profitable. But bTB claims are 'haemorrhaging' the budget, I'm told. Thus no insurance is offered after a claim, at least until a couple of clear tests, and then at a hefty increase in premium coupled with a reduction in potential payout.

The point HSE and the litigation lawyers made to my colleague, was that if the public and employees are made aware of a risk, then there is no basis for claim. It becomes their choice whether to expose themselves to it, or not. And that can only be done on a wide area (parish) basis. The crux of the posting is that it SHOULD be done.

Interesting your second point, in that cash was offered to the banks, with apparently no caveats as how it should be used. Hence the current wringing of hands over 'bonuses' and banks reducing their own debt but not offering funds to struggling but creditworthy, businesses who actually create wealth.

you quote, "HSE are at last beginning to wake up to 'aerosol' infection from all infected animals including wildlife".

they may be, but public health officials certainly aren't. we lost all 4 of our pet cats to bovine tb late last year / early this year. (we had one confirmed case and were instructed by defra to euthanize the other 3 (all the while our vets were telling us not to worry, "this doesn't happen; cats don't get tb"))

defra recommended that we (myself, my husband and our then 7yr old son) all be tested for btb ourselves but public health in our area of wales flat out refused us tests. i spent hours every day for weeks on the phone to everyone i could think of (private drs and hospitals, public health, the county's health board, newspapers, defra, etc) and had no success. now (10 months on from the initial cat's euthanasia and 8mos on from the other 3) we thankfully symptom-free but still unaware as to whether or not we were infected. i have also just heard of another case of btb in a domestic cat in our area.

we got conflicting information from everyone to whom we spoke. defra said that aerosol transmission was a serious risk; public health said "unpasteurized milk or infected udders" only. we would like now to get another pet but no one can even tell us whether or not our house is "safe".

the btb situation in the uk is a mess and a nightmare. it is being handled appallingly badly by people who don't seem to care about the health and welfare of animals or humans. just like most things in the uk.

Kira Lily; So sorry about your cats. We have said for a long time that this ruck in Defra's carpet will eventually trip them flat on their faces. Shooting sentinel, tested messengers (cattle) is not going to reduce the amount of m.bovis bacteria in the environment, which is available to any mammal - especially it would appear, to cats and alpacas.Unfortunately, the text books (often written about 1952) still refer to the primary cause of bTB as 'unpasteurised milk', and until they are updated based on the closing of that particular loophole in the 1960s by the eradication programmes in cattle and by pasteurisation, then cases such as yours will be lost in a fog of misinformation.

Were you able to get the particular DNA strain (spoligotype) of m.bovis which killed your cats? That would be available from your local AHO or through your vet. Failing that give VLA Weybridge a ring. It should be the particular one circulating in your part of Wales.

We are disappointed that your family have not been offered BCG tests for exposure to m.bovis. That is appalling, given a positive diagnosis on your cat and in such cases there should be automatic as a link between AHO and the public health authorities.

You really do need checking out, particularly the youngster.

Your house is probably fine, but somewhere close to it, 'something' capable of shedding this bacteria is living, and may give further exposure to anything in contact.

when i asked defra how our cats could've contracted the disease, our "agent" at animal health said (and i quote), "cows or badgers."not especially helpful, that.

we live on a farm (in a rented cottage). we are mostly surrounded by sheep although there are a few herds of cattle too; in fact at the moment i can see one from my window (or could if it was light out!).

while we weren't given the name of the particular strain that infected our animals, i was told by defra that it was the strain predominant in our area (the brecon beacons in mid wales).

i know that none of the herds that have been on the farm where we live have tested positive, but i also know that the man who keeps these herds has had btb issues in his other herds. and that there is/has been btb on the hills all around us.

i was told by our vet at the time (when i started complaining that although defra told us to get tested the nhs told us to go away) that farmers around here regularly get letters from animal health telling them to be tested, and then are turned away by their gps. it's partly (apparently) due to the fact that in powys we no longer have tb testing facilities (!!!) and cases are referred to the chest clinic (for x-rays, not a mantoux test!) at a hospital gwent. but of course public health for wales is based in dyfed!it's a logistical and bureaucratic nightmare. a gp i saw out of hours (and outside of our own practise) told me that public health are useless. that was reassuring.

my son is of course too young to have been vaccinated, and i was raised in america where the bcg vaccine is not used. and to be honest i strongly doubt the efficacy/safety of vaccines anyway, and so of course i fought for tests for us for months. in the end though i had to let go; i was getting nowhere and it had taken over our lives. i just hope we've heard the last of it all.

what worries me the most (aside from the lack of apparent concern for human health) is that it took the vets 4+ months to diagnose our initial cat, and even at the post-mortem were insisting that he didn't have btb. it was only when defra came back (2mos later) with the culture results that they conceded the cat had btb.

i shudder to think how many more families are going to have to deal with this in the future. we lost one cat the week before christmas and then had to put 3down w/in one week in february. it was devastating for us all as you can imagine, and my son is on the autistic spectrum so for him the whole episode was beyond horrific.

i really can't see how this is going to end, for anyone.

thanks for keeping up this blog anyway; it's nice to know some people out there are concerned and active.

Kira Lily.Having read your comments through again carefully, we consulted 'the boss'. Our co-editor is a published microbiologist, with a keen knowledge of disease transmission, and the responsibilities of those agencies charged with its control.

He has found a link to the most up to date guidelines, and suggests in the first instance you contact the HPU and copy everything to your MP. If you are still blocked, let us know and some PQs will be aimed, accurately, at the appropriate agencies. Meanwhile we have given your story more prominence as a stand-alone posting.

by the hpu do you mean the health policy unit? (sorry, my knowledge of such acronyms is limited to what google can tell me!)

i will (i think) do as you suggest. our mp seems somewhat gormless, but he might be interested in this (although he wasn't previously).

i must admit though that i am hesitant to undertake another foray into the btb nightmare. as much as we all feel traumatized by our experiences and feel that the public would benefit from hearing our story, we cannot re-immerse ourselves in the situation to the extent we did previously.

i also am concerned for this reason:during my research i discovered the various treatment protocols for btb, and found that long courses of antibiotics may be administered even when there is no immediate clinical need for their use. my son has previously reacted atrociously to antibiotics (the one time i let a dr convince me he needed them, and he ended up far more ill!!) and so there is no way i will let him have them again unless he actually needs them.

i don't know. it's all a muddle and to be honest much of me just wants to forget the whole incident. the fact that i'm posting here though means that i haven't.

i will have a think and a talk with my family and see whether or not we want to pursue the matter further.

i did speak last night with a local vet who has just dealt with another case of btb in a domestic cat (not a field cat in this case); its owners have also been refused tests.

thanks again for your help, and i'm sorry not to sound more enthusiastic. we've just had more than enough of btb at this point.

Kira Lily.We have now had a good scroll through the HPA booklet the boss found, and the statutory notification requirements are quite proscriptive.

Overseeing the whole lot is the HPA (Health Protection Agency)

'Bovine' TB is a notifiable zoonosis, and when confirmed in either human or animal a set of flow boxes should be set in motion.For Wales the body overseeing the procedure is the Communicable Disease Surveillance Centre (CDSC) and they operate under a Health Protection Team (HPT) Team not 'unit'.

This is a legal requirement when clinical disease of this category, is confirmed either in human or animal candidate. In your case, your cat(s).

Also gathering their chairs in a circle are a group called HAIRS (Human Animal Infection and Risk Surveillance ) p.15 of the HPA booklet.

bTB is a multi agency discipline, but that doesn't mean the agencies can pass the parcel around and no one pick up its statutory duty of care.

See P.16 : Responsibility for investigating transmission from animals to humans in a domestic session, rests with the HPA.

Initially the Mantoux test will indicate whether your cat has been involved with any onwards transmission. This, like the cattle skin tests, detects exposure to the bacterium which can cause bTB and not necessarily active disease. If this test is positive, I understand X rays are the next portal, and then prophylactic antibiotics last of all. But if clinical bTB is found, then that's a different ball game, and the long course of antibiotics which you describe becomes a necessary evil.

sadly we've already been down these routes. the hpa refer to the "nice" guidelines, which themselves mention only unpasteurized milk and/or the handling of infected udders as sources of transmission.("...testing should be limited to previously unvaccinated children and adolescents (age <16) who have regularly drunk unpasteurised milk from animals with udderlesions...")

and we have spoken directly (on numerous occasions) to the head of infectious disease control at the cdsc; he said in one conversation that the risk was "negligible", and in another that it was "non-existent". he quoted the nice guidelines at us verbatim. nevermind that they don't encompass exposure in a domestic environment.he asked jokingly if we ate cat food. we replied that no we didn't, but of course our cat had drunk out of our water cups when we weren't looking (cats do that). he told us the risk was non-existent.

following our multiple complaints, letters from our gp and an article in the local paper i received a letter from this individual apologizing for any distress through which we might have gone (that consoled us immensely as you can surely imagine) and stating that there was a communication problem between public health and defra and that the matter was being addressed. (ie, defra are giving out "wrong" information and the csdc are telling them to stop telling people to get tested.)

I don't understand, if a cat is put down with bTB the owners and all the family will be tested, no problem there. I am speaking from personal experience, having just come off the medication for avian TB which is not supposed to infect humans, and I asure you I am one. I spent 3 years on very toxic medication, which has left me with other medical problems.My cat caught the disease off me, and as a result, all my family were tested even though it is not passable to humans.I was told at the hospital that it was standard proceedure to test all people involeved when an animal or human gets any form of TB.So I do not understand why it is that this person and the family were noit tested, as bTB is is such a big issue.Sorry but something just doesnt add up here.

your experiences have obviously been very different to ours, and whatever you were told at hospital it is not sop to test the human contacts of a domestic animal infected with btb. perhaps the protocol is different with avian tb, and with a confirmed human infection.

Anon. 1.53If I read your comment correctly, you were the index case, being diagnosed with m.avium, not a domestic pet.From what we hear, the medical authorities are OK when they find a human being with TB, but it is the link upwards for a human contact with a bTB postive domestic pet, which is at the root of this posting. And that seems to be a stumbling block for some local authorities, but not all. In some areas, the liason between Defra and the HPA is good and human contacts do get screened, whatever animal it is that has tested positive.Others appear to be dragging their feet. Which, as TB (any sort) can be decades lurking, is storing up potential trouble.

AIDS is not the world's biggest killer, but TB as a secondary is. When the body is challenged by other stresses, it is then that ages old wallled up lesions may break down.

If I were to wager a guess at why, I’d say that users don’t “browse” forms. The interaction style users engage in with forms is different, and requires its own study and design best practices. This is a very interesting post, and the comments are also fantastic to read. I’ll have poses to have a little re-think about my own contact form on our new website, as this some interesting questions! degree home